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I have claustrophobia. Within the last year or so, when I've flown on an airplane, I'd have an anxiety or panic attack. Of course, this creates more anxiety, and I fly in fear that I will have another attack. I can go on a round-trip flight and have an attack on one leg of the trip, and then not have an attack on the other. I am in the aviation profession and am not afraid of flying. Any information you can give me would be greatly appreciated.

— Donna, Virginia

You describe the cycle of panic so well here, Donna. What often keeps panic in play is the fear of having another attack, along with other, peripheral concerns, like fear of embarrassment or fear of not being able to function. In your case, as you insightfully realize, it is not flying that distresses you but the fear of panicking when you fly.

It's great that you're in the aviation profession because that forces you to confront these fears. Avoiding the situations you fear can reinforce the feeling of panic. For example, if you avoided flying as a way to avoid panic attacks, the avoidance would relieve the anxiety and you would temporarily feel better. Of course, this would encourage you to continue avoiding flying. This cycle actually amplifies anxiety, and could even convince you that a panic attack is inevitable any time you fly.

So first off, I congratulate you for continuing to fly even though it is sometimes frightening; keep that up! Here are some additional strategies to help you reduce the risk of another panic attack in flight:

When you're flying, notice what you are doing when you're not panicking; you're probably focusing on something other than your potential to panic. Whatever we focus on becomes amplified in our minds, so focusing on a specific task can be quite helpful.

Learn a breathing technique to employ at the earliest signs of anxiety. There are lots of them out there. It can become a valuable tool for you can use when you recognize the presence of anxiety. It can also help you prevent the escalation of anxiety into panic.

Don't drink caffeine before or during the flight. Caffeine can increase heart rate and speed your breathing, which you could misinterpret as the early signs of a panic attack. The very thought that you are starting to panic can escalate the panic further.

Be sure to include regular, moderate exercise in your daily routine. It can reduce the physical signs of chronic stress, which you could also mistakenly interpret as early signs of panic.

Be sure to eat healthy foods around the time of the flight, including protein and fiber so that your blood glucose levels stay relatively stable. Sudden swings in blood glucose occur when we eat highly processed, sugary foods and can trigger physical symptoms like jitteriness and sweating, which can seem like the beginnings of panic.

Last Updated:4/16/2007

Dr. Ruth Wolever is a clinical health psychologist and the research director at the Duke Center for Integrative Medicine at Duke University School of Medicine.

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